75 percent of Obamacare participants are in red states. 
Running Out of Time?
The WSJ reports Congress Is Running Out of Time to Decide the Fate of Obamacare Subsidies
Enhanced Affordable Care Act subsidies are set to end after this year unless Congress acts, and open enrollment for insurance next year starts next month. Democrats have demanded that Republicans negotiate on extending the subsidies as a condition for ending the government shutdown, now in its third full week. Republicans recognize that many of their voters will be hurt by a cutoff in tax credits, but say the program known as Obamacare needs major changes.
Any deal to end the shutdown is expected to involve a fix for the expiring ACA subsidies, which flow to more than 20 million people. But extending the enhanced subsidies would be difficult to swallow for Republicans in Congress, who have spent the past decade and a half railing against the 2010 law that passed—and was later expanded—with only Democratic votes.
Senate Majority Leader John Thune (R., S.D.) says Republicans are open to talks on extending the subsidies only after the government reopens. Senate Democrats have repeatedly blocked a Republican bill passed by the House that keeps the government funded until Nov. 21. The House has been on break since mid-September, in a bid to keep the pressure on Democrats.
“That’s the conversation that we will have when the time comes,” Thune said, calling the ACA “desperately in need of reform” and pointing to possible changes to the subsidies to lower costs and address alleged fraud and abuse. “We can’t do it while the government’s shut down,” he said.
Thune has publicly floated an offer to vote on extending the subsidies after Democrats end the shutdown, without a guarantee that it would pass. But Senate Minority Leader Chuck Schumer (D., N.Y.) said Thursday that Thune had never approached him with any proposal, and insisted that Republicans need to sit down with Democrats and talk.
It is a galling predicament for many Republicans, who must reckon with the fact that a growing number of their own voters have come to depend on the subsidies, which would revert to lower levels and help fewer people if not extended. The enhanced subsidies spurred the number of ACA sign-ups to more than double since 2021, largely in red states. If kept in place, the Congressional Budget Office estimates they would expand the federal deficit by about $350 billion over 10 years.
More than three-quarters of Obamacare policyholders now live in states that voted for President Trump, according to KFF, a health-research nonprofit. In Barrasso’s state of Wyoming, for example, ACA sign-ups totaled 46,643 this year, which was 90% higher than 2020, KFF says.
Trump’s endorsement will be key to corralling enough Republican votes for any compromise. Any ACA legislation risks exposing deep divisions among House lawmakers in particular.
Republicans who are open to extending the subsidies say that they won’t do so without a major overhaul, which would take time to draft and negotiate.
GOP lawmakers also argue that a big share of ACA enrollments could be fraudulent, involving people who might have been signed up for subsidized coverage without their knowledge, by brokers or others. The sprawling tax legislation that Trump signed into law in July included provisions tightening sign-up procedures for ACA plans, which will take effect for coverage that starts in 2028.
Rep. Marjorie Taylor Greene (R., Ga.) said on social media recently that she is no fan of Obamacare but that her party needs to get to work to solve the crisis.
“I don’t think that is too much to ask,” Greene said.
Reform Needed
There is no doubt Obamacare needs reform. But Republicans won’t talk until Democrats end the shutdown.
But why should Democrats believe Republicans on anything?
I still suspect this will end the way it always has: more free money and no reform.
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The clock ticks on another trade war escalation.
Meanwhile, there is Zero Progress on the Reducing the Deficit Despite Tariff Revenue
For fiscal year 2025, the deficit is $1.8 trillion, similar to 2024.
Any deal with Democrats is nearly certain to increase the deficit.
So Medicaid for the blue states and Obamacare for the red states
Gosh, here is a solution. Force providers to post fees as Trump required, incentivize insurance members to pick lower cost providers.
Can we even try that? Hello, is there anybody out there?
Have you ever looked at a medical EOB? It can be pages and pages of codes for a single procedure. There is no way to do price comparison with a system like this.
What is needed is ato remove all these codes and show the price by procedure. But I am not even sure if that is possible since there are so many nuances to medical procedures.
Some yes but not always. A few years ago, I was able to get the codes and costs on my triple hernia surgery before I scheduled it. I was with Christian Healthcare Ministries (CHM) so I elected to go on a 1 year payment plan initially and then CHM reimbursed me a couple of months later. The only downside was a really late bill from a nurse anesthetist who was contracted by the hospital. The main anesthetist had already been paid. Even on that bill though, she extended a 40% discount due to the late bill of $300.
There’s no solution …
Either you subsidize healthy people so they sign up or you don’t, in which case they will take the risk of not being adequately covered. There is no pool of payers to pay for those with pre-existing conditions. There is no financial model that works.
Unless, you have the rule of law and prosecute medical/pharma sector racketeering.
Posted in wrong spot. Please ignore.
Okay, stupid data question- do we know how many actual people per state, the raw numbers, are signed up. Growth can be a misleading thing on a period over period basis if say there are 5 MM signed up in NY and only 500,000 in many of those southern states. It would also be interest to see how many are signed up as a percentage of total population.
There’s a table on the page linked below that shows total ACA enrollment by state. Some states rely on it heavily, like Florida for example where almost a fifth of the population is covered under the ACA.
https://acasignups.net/rate_changes/2026
if you are still caught up in D v R in pax dumbfuckistan, please never change. the oligarchs will steal everything not nailed down. just like the previous empire of USSR when she collapsed. i was doing business in russia in 90s. very similar vibe now.
All this hoopla over $35 billion/year in a $7,000+ billion/year budget. They need to get this silly fight over with and move on already.
The prez wants to commit more than this amount to Agentina and no one cares.
I agree. They need to pass this, for the middle and working classes, who are trying to make ends meet.
No. Obamacare subsidies need to end permanently. Tax payers shouldn’t have to pay for other people’s healthcare. I’m middle class and I pay over $1,000 a month in premium for a $3,300 deductible. Tax payers don’t subsidize my healthcare premiums.
FYI: Grok reports a quite different breakdown:
Q: What percent of ObamaCare participants are in so-called red states vs. blue states (ignore swing states)?
A: Red States: ~35% of ObamaCare participants.
Blue States: ~46% of ObamaCare participants.
(Remaining ~19% in swing states, excluded per request.)
Notes: These figures adjust for 2025 OBBBA effects (e.g., subsidy cuts for immigrants) and assume stable enrollment trends. Data is sourced from KFF State Health Facts and HHS Marketplace reports (kff.org, hhs.gov). Verify with the latest 2025 Q3 report for precision.
That is close to what I was looking for. Raw numbers in total and for each state would be even better. Just to get my numerical arms around it.
So go ask the AI.
“But why should Democrats believe Republicans on anything?”
Because the Dems are the ones lying about illegals & Medicaid. The Dems are the party of hypocrisy & lies at a rate 10x what the GOP engages in.
Because the GOP will have to contend with angry voters in their states that will see large premium increases. But more than likely, the Dems know that the GOP want to extract more cost savings from ACA aside from the subsidies, so they’re trying to run this out as long as they can. They know they face an uphill battle with the GOP controlled Congress.
This is a classic government shut down, cry & moan long enough to try to force the other side into larger concessions.
Hilarious.
I agree. The Dems are idiots.
Ah, the new White House PR intern has joined the forum.
There’s already a strong divergent trend in life expectancies in red vs blue states. Current trends like cuts to Medicaid and Medicare, increasingly limited access to health care providers in rural areas, restricted access to women’s reproductive choices, anti-vaccine sentiment, anti science sentiment, etc etc etc will all accelerate the trends. It’s sad to see.
Fraud in Obamacare, you bet. I see it in my line of work. I also think we have to make sure to give Justice Roberts, the man who took and rewrote the law to make it pass legal muster all of the real credit here. All of this crap needs to be rolled back- not just Obamacare but medicare and medicaid simply are not sustainable. Eventually the three generations after Gen X are going to say enough, and cut a whole lot of the socialist programs from the 40’s, 50’s, 60’s and 70’s that spawned so much of this not completely, but substantially to be sure.
You can never go back!
The problem is the high cost of practicing medicine. There are two ways to control costs, either a free market, with some people excluded because of income or a single payer system like Europe. The hybrid, giving every entity a cut of the pie doesn’t work. Take your pick or the taxpayer will be forced to pick up more and more expenses.
Part of the answer is forcing people to live healthier lifestyles by associating their premium with their health risks. You have to make people have skin the game. And you have to find ways to reward healthcare to tries to save money. In addition, some form of price controls have to be answer in what you’re rightly calling a hybrid system.
Price controls are what a single payer system does. Instead of making 700 grand a year the physician is forced to take far less, The same for the entire chain of care. Of course, shortages develop. Either the price system rations care or the government does the rationing. The current system is far too expensive.
The current system is far too expensive.
You think? And there has to be radical changes to save money. Again, some form of price controls would be part of the answer. How much is the question, and FYI – you can have some level of price controls outside of a single-payers system.
What’s missing is competition to provide great, affordable healthcare.
Tort reform by limiting payouts, again, would be PART of the answer as well.
Another thing would be to create a uniform playing field. Create base national standards that states can add to but have to meet as minimums. An insurer should be able to sell healthcare nationally without having to be “licensed” in each state.
There are a million things that can be done, but the 3-4 changes I’ve noted are a great start.
Everything will be fixed when the AI’s take over and their robot workers do all the work.
Meanwhile, see my post ablv for something that sounds like it could cut costs:
https://mishtalk.com/economics/obamacare-growth-is-hugely-in-red-states-but-showdown-continues/#comment-381569
There is an infinite supply of immigrant doctors. They make $50K a year tops in their home countries and $260,000+ here. Doctors in Argentina make about $20K USD a year BTW, and they have excellent training. Any talk of “doctor shortages” is pure BS.
That doesn’t work.
Premiums can never go down because the majority of the healthcare costs are salaries and benefits. These can never go down or workers would be very unhappy!
the only way to reduce salaries and benefits is to automate jobs away or move jobs to a lower cost local, such as overseas somewhere.
prediction. trump will rename affordable care act to trumpcare, with more juice for the red states, and the repugs will pass it. long live idiocracy. trump is amerika. democracy works. hat tip republic penned by plato. they knew.
The train to bankruptcy is still on the tracts.
Trump can’t do a damn thing without Congress, and he certainly can’t make really huge changes to ObamaCare without 7 or so votes in the Senate.
Democrats should cut a deal – let Obamacare subsidies expire in the red states and close all rural hospitals that receive funding through the federal government. That should save some money and please republicans who want to end the subsidies. Democrats should stop bailing out the people that never vote for them.
What you are propsing here is taxation without representation for Republican states. Also, since all those Republican tax dollars would be funneled to Democrat run states under your proposal, your final sentence is more hypocritical than sarcastic.
Sorry, but they’re fully represented.
Federal tax dollars come from all states, and the proposal would substantially decrease the benefits given to red states while engorging blue ones.
They are NOT cutting ALL subsidies they are just going back to what they were before covid. What this really shows is the real cost of Obama care and how the health care system is broken.
Hey… well said!
Anyone voting to extend enhanced ACA premium subsidies is a Democrat and not a Republican. It’s that simple. Subsidies push up premium prices in a never-ending annual snowball accretion. Dramatically scaling back subsidies will fix more problems than continuing those subsidies will create.
PS What’s the average annual increase in ACA premiums so far, 10%? Next year it’s projected to to be 18%. Anyone who votes for this crap needs to review the poem, “The Charge of the Light Brigade”.
Nah, any Republican who votes to extend the ACA subsidy is simply willing to take campaign financing from the health insurance industry.
Republican voters are learning what FAFO means. The Trump led cult known as MAGA is hurting Americans more and more every day but they still believe it’s the Democrats that are hurting them. They are dragging America into the abyss, too bad chants of USA, USA, USA are as useless as prayers. There only hope is to 86 Trump and his cabal.
Here’s something that sounds interesting for people w/o medical coverage (or losing it):
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Virtually everyone keeps ignoring that these ENHANCED ACA subsidies that are being argued over were TEMPORARILY put in place by a DEM Congress in 2020 due to the Covid pandemic and they were made to expire come Dec 31 2025.
The base ACA subsidies will still be in place after these ENHANCED subsidies expire. So why the argument?
The answer is that the Dems are desperate to pin something on the Pubs and gain some respect from their base and this is all they could find to focus on that would hit the most amount of people.
The Pubs should stand firm. Start the government layoffs/firings and see who blinks first.
Yeah, I unfortunately spent 20 years in Ohio, and the MAGA there will smack into reality very quickly unless more money is blown to continue ACA or they can’t pay bills anymore. Take a look at every dark green state and tell me republican voters won’t be angry.
There will be a reckoning…
Those aren’t Republicans on Obamacare in those red states.
I know Texas Republicans who are on Obamacare. I’ve heard them joke about hating Obama, but loving Obamacare.
Some of those states have like 70% of their populations on federal health subsidies… Explain to me the math where that doesn’t include Republicans
When I lived in the US I thought healthcare was great…..because I worked for a healthcare company and got free healthcare from them….pay and the doctor and submit your receipts. No waiting, no worrying whether the bill will be paid. Now I think socialised medicine is the only way to go.
African Americans in the South don’t vote Republican.
Illegals in TX and AZ don’t vote Republican.
And what about Iowa, Indiana, Ohio, and West Virginia? How did those states vote last time around?
It’s predominantly the Dems in those red states on Obamacare not Republicans. Think.
Then you have nothing to worry about in your imaginary view of the world. Midterms are a year away….
Somebody needs to think. It’s not MPO.
‘Thinking’ would be even easier if you would provide the source for this claim.
Illegals are not on Obamacare.
Yes, the health insurance noose will tighten around many necks under Trump’s policies. The fixed income folks will choke first followed by those on the margin then as layoffs continue into the Trump recession, it will hit all the middle class folks.
Oh and don’t forget soaring food prices, auto and home insurance, tariff tax inflation and soaring utilities.
This is the “golden age” idiots voted for so enjoy it. How’s owning the libs working out?
https://www.nytimes.com/2025/10/17/health/aca-health-insurance-costs.html?unlocked_article_code=1.uU8.kX5c.bb_5vL7-gDYA
Got exit strategy?
I don’t buy those proposed scare numbers being thrown around.
A family of four in Maine living on 130k should be able to easily pay for their healthcare needs in cash and swing over to Canada if they need any serious attention.
People should look into medical tourism for their medical needs and forgo US health insurance. Put the money you would have paid for insurance into a savings account.
Also, $130k is not a shabby income, outside of CA, metropolitan NY and a few other places. Many families live successfully on half of that. Many SS receipts live on half of htat half or evenless.
STOP THE WHINING!
“… swing over to Canada if they need any serious attention.”
Huh? What happened to all the bullshit talk that Canadian health care system is collapsing yada yada yada?
Lol. Who’s whining? I want all of this socialism to come to an end. That includes medicare, social security and related programs. 100% shut it off.
I find it hilarious that your solution is to go to Canada or medical tourism because if that’s the solution then why not just leave the US altogether and lower all your costs across the board and not have to deal with toxic MAGA as a bonus.
I hope the GOP doesn’t cave so that the costs can soar, people get screwed and the whole thing collapses and gets rebuilt from scratch. But I think what will happen is the GOP will cave, throw money around then kick the can down the road so that’s it’s 10x worse right when 80m boomers get on the dole in 2030.
I ask again got exit strategy?
They will go back to the to showing up at the ER with the sniffles, and the federal government will pay vastly more than 35 billion. Trump has written a great big beautiful health plan. It’s ready to go. Neurosurgeons will be making $15 an hour. About one dollar an hour for each year of training. Healthcare will be cheap. People who can’t afford brain surgery will be allowed to go to their local veterinarians and barbers.
Shouldn’t a family of four generally have at least one adult with employer sponsored healthcare?
Do all employers provide healthcare? And what about those that run their own business?
Perhaps the solution is to require employers to provide some basic level of health insurance to ALL employees then?
I just can’t imagine how a family of four making $130k has no employer sponsored plan? Maybe that’s how it is in Maine.
To your second question, my daughter works for a Ma & Pa outfit with 3 employees, and they provide a healthcare benefit. The owner is a worker as well.
I’m not intending to be insensitive, but I wouldn’t sleep well at night until I landed a job “with” healthcare benefits for my family.
Overall premiums for 2026 are going up ~20% where I work.
Exactly. Stop whining and fork over more than 10% of your 130K income please. I cant believe people are upset over that.
The only profitable entitie in healthcare are the Insurance companies.
That is the problem ~ Get the insurance companies out and healthcare can be outcome oriented instead of profit oriented for the insurance companies.
How about get the PROFIT out of healthcare?
Make the business non-profit and then watch that they don’t outrageously jack up everyone’s salary, which is what nonprofit’s do.
How about get the investment banks out of health care. Unions too. Subsidizing premiums just shifts the cost. We need to get costs lower.
Investment banks don’t “invest” in non-profit’s because there is no profit to capture.
As to unions, they are a pox on the world and should be banned. The owner you work for sets the rules. If you don’t like the rules, go someplace else or start your own business.
Spoken like a true wage slave.
The reason, the single reason, manufacturing jobs contributed to the rising middle class in America is Unions.
And the reason that many manufacturing jobs went overseas, to countries like China are, wait for it, drum rooooooooooooollllllllll – UNIONS!
Of course not. No one in their right mind would sell in a highly competitive market with a single buyer. Especially when selling something that expires quickly (time, in this case). In such a market you have to unionize to even the negotiating power.
If I’m the owner and you don’t like my rules, then go elsewhere. I don’t want you working for me. I will hire someone else or automate all your jobs away.
The age when labor had value is gone, destroyed by AI/automation and the coming of humanoid robots to the work floor.
Presumably congresspeople of both parties – including republicans in “red” states – are well aware of their constituents’ opinions about Obamacare. The fact that Obamacare policyholders are over represented in red states doesn’t mean that they vote republican.
correct.
Yes, in 2024 huge numbers of Red State Democrats finally got around signing up for Obamacare.
Like ive said before the average republican would do better voting dem. At some point maybe they will realize the republican culture war is a distraction The republican policies are for the very wealthy but they need your votes.
But it wont matter. Now that the average republican is waking up the politicians will just super gerrymander to keep their power.
Both parties gerrymander. In 2024 Republicans candidates in California garnered 39.34% of the vote and ended up with only 17.3% of CA’s House delegation. States like Washington and Maryland are similarly gerrymandered.
i was a cartographer in 1980s. we used the most sophisticated cad/cam systems available, department of war grade computers. we were gerrymandering one of the largest states in usa. as a young 20 something it was a great education to an old art form. one republican state senator in corner office and one dem state senator in other corner office. the horse trading was out in open in our office. nothing new except the tech.
In the 1980s the Voting Rights Act was fully in place.
The last 2 times there was a shutdown, the supposed sticking points were never granted.
Back in 2018, it was “the Dreamers” that was holding things up. A year later it was supposedly “funding for the border wall” preventing a budget deal.
Both of those shutdowns resulted in a budget without resolving the supposed main issue.
The same will happen this time. Miraculously they’ll come to an agreement without granting the ACA extension.
What’s really going on? The politicians need more time to wheel and deal to decide who gets what in a huge multi-trillion dollar spending bill where the public has no actual idea about what’s actually inside of it.
Red states are not bombarded with the massive numbers of illegals, such as blue states have. $3B was the shortfall for California, and even hard left, CCP-paid L.A. Times had to report that. Red states, conservatives, know how to manage their money, and spend within their means without box-checkers, and virtue signal for votes. Wake up, everyone. The California Democrats have been in bed with the CCP for decades. NYC: Mandani is a danger.
Red states have people who are not on the dole. They pay for their care. Big difference.
Texas and Florida both bombarded with illegals
The following link from Kaiser shows the estimated number of people receiving ACA premium subsidies, by state:
https://www.kff.org/affordable-care-act/state-indicator/average-monthly-advance-premium-tax-credit-aptc/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Number%20of%20Marketplace%20Enrollees%20Receiving%20Advanced%20Premium%20Tax%20Credits%22,%22sort%22:%22desc%22%7D
Four states account for over half of all people in the USA receiving ACA premium subsidies: Florida ~4.5 million, Texas 3.7 million, California 1.7 million, and Georgia 1.4 million.
PS Another 1.7 million ACA subsidized individuals are enrolled in New York, but the state uses creative accounting to “hide” almost all those enrollees in the New York state “Essential Plan” healthcare.
I’ll never forget taking a detour in the 1990s in a town in Nebraska and suddenly it looked like I was back in Oak Cliff in Dallas. Purple, green, yellow, and pink houses. The local packing plant had discovered undocumented Mexicans. And just like that, they finally had decent places to get a taco. In Nebraska.
I’ll wake up when you do. Until then, no thanks, I’ll go with reality.
My word, that’s quite the rosy picture you have of red states. Great that people there are not on the dole. That will save a ton on those farm subsidies trump is about to hand over to them.
Taco could care less.
Facts don’t matter.
The Re-Brander In Chief loves the quick fix:
ObamacareTrumpcaresmostproblem solved.
bingo. been saying this for months myself.